Expected and Unanticipated Consequences of the Quality and Information Technology Revolutions
- Author Affiliation: Department of Medicine, University of California, San Francisco.
- Corresponding Author: Robert M. Wachter, MD, Department of Medicine, University of California, 505 Parnassus, Box 0120, San Francisco, CA 94143-0120 (bobw{at}medicine.ucsf.edu).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
Nearly 2 decades after the prediction that an age of “assessment and accountability” would soon transform health care,1 the quality movement has finally arrived. Driven by evidence that US medical practice comports with best evidence approximately half the time,2 that large numbers of medical errors continue to occur,3 and that clinically indefensible disparities in care exist across regions4 and racial and ethnic groups,5 health care payers and the US government have decided that quality should be measured, publicly reported, and perhaps even compensated differentially. The latter trend, known as pay-for-performance, has been strongly endorsed by the Centers for Medicare & Medicaid Services.6
The scientific underpinnings of quality measurement are rising to the task. Donabedian's insight7 to divide quality into structure (how care is organized), process (what was done), and outcomes (what happened to the patient) is the quality movement's scaffolding. Its planks are …
